In-house remedy for doctor shortage

May 14, 1999

The Open University with Leeds medical school is bidding to teach some of the 1,000 extra medics Britain needs. Julia Hinde reports.

If you are bored with your job and looking for a new career, you might soon be able to add a new option to your list - without it costing you an arm and a leg. A career in medicine has, until now, generally meant a decision on subject options at 16. For all but the most committed and financially optimistic, a second degree in medicine is a frightening possibility.

Returning to university, already burdened with student debt, for a minimum of another five years, has dissuaded many would-be medics, particularly those with young families, from a future life by the hospital bed.

But the tide is turning - or at least it might be. The Open University is hoping - if it gets the go-ahead later this month from a joint Department of Health/Higher Education Funding Council for England group - to break the mould by offering an easier second path into medicine, enabling graduates to train without giving up their job.

The university, which for the past three decades has been a pioneer of distance learning, is proposing a revolutionary medical foundation course.

From the confines of their living room, anyone from a solicitor or banker, or even a university lecturer, could - with about 20 hours a week - start their medical training, while still earning money working.

The course, in fact, will not be open to everyone in the way most Open University undergraduate degrees are, but will be strictly limited in numbers (3 places are being proposed in the first instance). It will only be open to graduates.

Depending on their first degree, students, selected on the basis of interview and possibly psychometric testing, would study the OU foundation course from home over a predetermined two to four years. If they pass all the exams, they will automatically progress to the third year of Leeds University medical school, or even to a new proposed medical school in the southwest (also being discussed by the DoH/HEFCE group responsible for distributing the 1,000 extra medical places agreed to by government) for a further three years.

The course means would-be doctors only spending three, as opposed to five, years without paid employment.

"It's not possible to become a doctor without some disruption in your life," says David Cottrell, director of undergraduate studies at Leeds University school of medicine. "This course is only three years of supporting yourself. But we genuinely believe it will make a difference, and make it a lot easier for would-be students."

But once accepted on to the foundation course, what can tomorrow's doctors expect when it comes to teaching?

Though the OU has gone a long way towards designing the basic curriculum, the exact course has yet to be written. The university will need to employ new staff with experience in writing preclinical and clinical courses before it can do that. However, it will also be turning to its existing biological science staff who have many years of experience in writing distance-learning material.

"Because we are starting with a blank sheet of paper, we can integrate clinical skills from day one," says Lynne Orton, co-ordinator for curriculum initiatives. "We are taking three key strands from the General Medical Council's policy document, Tomorrow's Doctors - life sciences, human sciences and professional development - and will be running them through the curriculum from the start."

It is expected that around two-thirds of the home study course will use conventional text learning to teach the basics of areas such as metabolism, nutrition and neuroscience, with a third of home-time using new technologies, such as videos, audiotapes or CD-Roms.

But on top of this there will be basic and clinical lab classes and exposure to patients. The OU is planning residential courses to enable students to undertake supervised lab and clinical work, and have also proposed that foundation course students spend eight days a year exposed to district general hospitals or community-based medicine.

Students will have a continuity tutor throughout to monitor their progress. It is hoped that students will keep the same continuity tutor from the day they enter the proposed foundation course to the day they graduate.

On top of the continuity tutor, foundation-course students will have subject tutors working with them through different elements of the course and clinical tutors to guide them in the clinical work.

All players are confident that foundation-course graduates will have sufficient basic science, as well as clinical and professional experience, to merge easily into the third year of an existing medical degree, such as that offered at Leeds.

"The idea is they will be mixed with Leeds students," explains Professor Cottrell, who is confident that existing students and other medics will welcome OU graduates.

"We hope both will see them with extraordinary enthusiasm," he says. "People have been saying for years that they have concerns about the way doctors are selected and whether it's right to select people purely on academic ability at 18, and perhaps that the kind of doctors we have do not reflect the population. This course is committed to attracting mature students and ones with different backgrounds."

"Our students see this as a good development," he adds. "From other doctors in West Yorkshire where these students will have clinical placements, we have had nothing but enthusiasm."

The OU and Leeds plans are still waiting for the green light. The implementation group, which will decide whether the plans become reality, has received 21 bids from universities each keen to capture a proportion of the 1,000 extra places.

The group has asked for further costing evidence from The Open University.

But the group's interest may mean nothing when it comes to the crunch. There are far more places being proposed by universities than being offered by government. At the end of the day there will be winners and losers. Professor Cottrell is certain that, given the chance, the OU and Leeds will be able to produce doctors fit for practice in the 21st century.

"We have no doubt we can deliver this course and that it will be excellent," he says.

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